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[Guidelines for vitamin D prescription in dialysis patients].
Nephrol Ther 2009; 5(6):520-32NT

Abstract

The vitamin D hormonal system is involved in the regulation of more than 800 genes. Vitamin D deficiency, which is evaluated on the basis of the serum level of 25-hydroxycholecalciferol (25[OH]D), is frequently observed in the general population, particularly in patients with chronic kidney disease (CKD). Vitamin D deficiency is associated with an increased risk of falls and fracture and also with diabetes, malignancies, autoimmune diseases, depression and mortality. Furthermore, CKD is accompanied by a decrease in the renal production of 1,25 dihydroxycholecalciferol (1,25[OH](2)D). Such deficiencies have also been implicated in the pathophysiology of secondary hyperparathyroidism. Currently, vitamin D supplementation is not recommended in stage 5 CKD. However, since there is also significant extra-renal production of 1,25(OH)(2)D this would appear to be in favour of vitamin D treatment. We describe the disturbances of vitamin D metabolism occurring in CKD and discuss the advantages and the potential toxicity risk of vitamin D supplementation as well as the optimal serum 25[OH]D level. We then present the pharmacological properties of the various medicinal forms of vitamin D derivates and suggest therapeutic guidelines for supplementation with 25(OH)D(3) or cholecalciferol. We also examine existing guidelines for the administration of active 1-alpha-hydroxylated vitamin D. Despite the absence of strong scientific support by randomized controlled intervention studies, vitamin D supplementation should be considered in patients with CKD stages 4-5D having vitamin D insufficiency or deficiency, for the prevention of secondary hyperparathyroidism and for other potential benefits owing to its pleiotropic effects.

Authors+Show Affiliations

Centre de rein artificiel, néphrologie et dialyse, 69160 Tassin-La-Demi-Lune, France. guillaume-jean-crat@wanadoo.frNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Review

Language

fre

PubMed ID

19748843

Citation

Jean, Guillaume, et al. "[Guidelines for Vitamin D Prescription in Dialysis Patients]." Nephrologie & Therapeutique, vol. 5, no. 6, 2009, pp. 520-32.
Jean G, Lafage-Proust MH, Massy ZA, et al. [Guidelines for vitamin D prescription in dialysis patients]. Nephrol Ther. 2009;5(6):520-32.
Jean, G., Lafage-Proust, M. H., Massy, Z. A., & Drüeke, T. B. (2009). [Guidelines for vitamin D prescription in dialysis patients]. Nephrologie & Therapeutique, 5(6), pp. 520-32. doi:10.1016/j.nephro.2009.07.010.
Jean G, et al. [Guidelines for Vitamin D Prescription in Dialysis Patients]. Nephrol Ther. 2009;5(6):520-32. PubMed PMID: 19748843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Guidelines for vitamin D prescription in dialysis patients]. AU - Jean,Guillaume, AU - Lafage-Proust,Marie-Hélène, AU - Massy,Ziad A, AU - Drüeke,Tilman B, Y1 - 2009/09/12/ PY - 2009/03/13/received PY - 2009/06/23/revised PY - 2009/07/12/accepted PY - 2009/9/15/entrez PY - 2009/9/15/pubmed PY - 2010/3/23/medline SP - 520 EP - 32 JF - Nephrologie & therapeutique JO - Nephrol. Ther. VL - 5 IS - 6 N2 - The vitamin D hormonal system is involved in the regulation of more than 800 genes. Vitamin D deficiency, which is evaluated on the basis of the serum level of 25-hydroxycholecalciferol (25[OH]D), is frequently observed in the general population, particularly in patients with chronic kidney disease (CKD). Vitamin D deficiency is associated with an increased risk of falls and fracture and also with diabetes, malignancies, autoimmune diseases, depression and mortality. Furthermore, CKD is accompanied by a decrease in the renal production of 1,25 dihydroxycholecalciferol (1,25[OH](2)D). Such deficiencies have also been implicated in the pathophysiology of secondary hyperparathyroidism. Currently, vitamin D supplementation is not recommended in stage 5 CKD. However, since there is also significant extra-renal production of 1,25(OH)(2)D this would appear to be in favour of vitamin D treatment. We describe the disturbances of vitamin D metabolism occurring in CKD and discuss the advantages and the potential toxicity risk of vitamin D supplementation as well as the optimal serum 25[OH]D level. We then present the pharmacological properties of the various medicinal forms of vitamin D derivates and suggest therapeutic guidelines for supplementation with 25(OH)D(3) or cholecalciferol. We also examine existing guidelines for the administration of active 1-alpha-hydroxylated vitamin D. Despite the absence of strong scientific support by randomized controlled intervention studies, vitamin D supplementation should be considered in patients with CKD stages 4-5D having vitamin D insufficiency or deficiency, for the prevention of secondary hyperparathyroidism and for other potential benefits owing to its pleiotropic effects. SN - 1872-9177 UR - https://www.unboundmedicine.com/medline/citation/19748843/[Guidelines_for_vitamin_D_prescription_in_dialysis_patients]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1769-7255(09)00183-7 DB - PRIME DP - Unbound Medicine ER -